Living Up To Expectations: Pathological Demand Avoidance in Autism

Many people with autism experience Pathological Demand Avoidance (PDA) without even knowing it. But what is it?

The avoidance of demands and expectations of others, or even of oneself. That is what Pathological Demand Avoidance is for a person with autism.

Individuals who experience PDA say that while they may want to meet demands or expectations, they’re often unable to do so. Ordinary tasks like eating in response to hunger cues can invoke a sense of dread of anxiety, which can prevent them from meeting the demand.

They may “freeze” or find themselves in a state of fight or flight. Because people who experience PDA do not demonstrate characteristics of what autism is thought to “look” like, they may go undiagnosed/misdiagnosed for years.

Here are common traits to look out for in PDA individuals:

• Need for autonomy and control
• Resists the demands of everyday life
• Resists preferred activities
• Passive behavior
• Doesn’t understand a hierarchy
• Difficulty interpreting social interactions or situations
• Difficulty with emotional regulation or mood swings
• Sensory differences, including sensory seeking or sensory sensitivities
• Impulsivity or difficulty with self-regulation

Some helpful forms of therapy include:

• Hippotherapy (therapy with horses)
• Music Therapy
• Art Therapy
• Speech and drama classes

Although they may benefit from structure and routine, to them, it may feel like a demand. Instead of a fixed, imposed schedule or routine, give them as much freedom and autonomy over their lives as you can.

Pathological Demand Avoidance comes with its own unique challenges. Identifying and treating it will allow you to better support the needs of your loved one.